In their study, published in the Australasian Emergency Nursing Journal (14(4), 232-239, 2011), Praneed Songwathana and colleagues evaluate the success and outcomes of implementing a clinical nursing practice guideline (CNPG) for preventing deep vein thrombosis (DVT) in critically ill trauma patients at Songklanagarind Hospital in Thailand.

 

Despite the availability of treatment, the prevention of DVT "is more effective in promoting positive patient outcomes and is an important aspect of nursing care" for patients who have undergone major surgery and traumatic injuries.

 

According to the authors, the CNPG, which was revised by an expert panel, contained 30 items and was implemented by 42 nurses. It was evaluated in terms of (1) feasibility and difficulty of using the CNPG, (2) nurses' satisfaction in the implementation of CNPG, and (3) the patient’s femoral blood flow velocity before implementation and after 7 days.

 

Results from their study show that the implementation of the CNPG for DVT improved blood flow velocity in patients receiving both mechanical and medical prophylaxis, especially among high-risk patients. However, the implementation of many of the items outlined in the CNPG raised challenges in regards to funding, resources and nurses' skill/experience. For example, while foot exercises were successfully implemented in most cases, the use of compression stockings varied due to lack of resources. In addition, anticoagulant medication was less likely to be prescribed by a physician unless a nurse made the request, which was less common among novice nurses.

 

Nevertheless, the nurses in the study reported high levels of satisfaction with the implementation of the CNPG. This was due to several reasons, including the nurses' involvement in the establishment of the guidelines, as well as their access to a practical CNPG handbook containing detailed explanations of risk assessments and nursing interventions. In terms of patient outcomes, the results show increases in femoral blood flow velocity in the first 7 days after admission.

 

The authors conclude that the implementation of evidence-based clinical practice guidelines for the prevention of DVT is beneficial for both nurses and patients. "Almost all nurses (97.5%) reported that this CNPG was essential and feasible to practice in the trauma care setting." At the same time, "Patients also received better care as a standard to prevent DVT and gained more safety as part of quality of care indicators in trauma and ICU."